Agenda and draft minutes

The evacuation procedure was noted.

There were no interests declared.

To approve the minutes of the last meeting held on 19 November 2024.

Consideration was given to the minutes from the Committee meeting held on 19 November 2024.

AGREED that the minutes of the meeting on 19 November 2024 be approved as a correct record and signed by the Chair.

Senior representatives of North Tees and Hartlepool NHS Foundation Trust (NTHFT) were once again present to give a further update on developments in relation to the Trust’s maternity services. This was the third such update following issues raised by the Care Quality Commission (CQC) in 2022 regarding NTHFT maternity provision, with the Trust asked to also include details of the review of its community midwifery offer after concerns were raised by the Committee in early-2023.

Led by the NTHFT Associate Director of Midwifery and supported by the NTHFT Director of Nursing, a presentation was given which covered the following:

·       Perinatal Organisational Structure: The key difference to the structure outlined during the previous update in November 2023 was the addition of the ‘Group Executive Team’ which reflected the ‘Group’ model NTHFT and South Tees Hospital NHS Foundation Trust (STHFT) was now operating under.  All other roles within the structure remained the same.

·       Maternity CQC Position: Responses undertaken in relation to the five ‘must do’ (and one ‘should do’) actions identified by the CQC in 2022 were highlighted – these formed an important part of the Trust’s maternity safety support programme.  Progress had been presented to the NTHFT Board in order to provide assurance around compliance – sustaining (and continuing to monitor) this was vital.

·       Maternity Improvement Plan: Noting that the North East and North Cumbria Integrated Care Board (NENC ICB) now had oversight of NTHFT maternity service quality, several elements associated with improving the local offer were outlined, including the Maternity Incentive Scheme which saw the Trust compliant for year 5 (the first time this had been achieved for some time – a great credit to staff) and on-track for compliance in year 6.  In response to the results of the CQC Maternity Survey 2023, work around new methods for induction of labour was another key focus, with efforts being made to improve the labour experience by moving away from outcome-driven pharmaceutical interventions, and towards more mechanical methods which enabled women to return home during the process (if appropriate).

From a workforce perspective, there was currently only three whole-time equivalent vacancies within the whole service, a significant improvement on the staffing situation this time last year.  Following responses to previous CQC surveys / inspections, the Trust was also involved in a national perinatal culture and leadership programme.  NTHFT recognised that culture impacted upon recruitment and retention, and this initiative would help identify priorities for the perinatal service.

·       Service Improvement: Continuing the theme of enhancing provision, feedback on work to improve the community offer was relayed.  NTHFT had aimed to expand the choice of community-based appointments (along with how these were communicated / promoted) and had established more flexible service timings to fit in with the contrasting work patterns of pregnant women.  Short bite-sized videos were being produced in conjunction with Teesside University to assist with parental education, and the Chair of the Maternity and Neonatal Voices Partnership (MNVP) was continually involved in discussions to strengthen local provision.  ...  view the full minutes text for item ASCH/51/24

To consider information from the North Tees and Hartlepool NHS Foundation Trust (NTHFT) in relation to this scrutiny topic.

The third evidence-gathering session for the Committee’s ongoing review of Reablement Service considered information from the North Tees and Hartlepool NHS Foundation Trust (NTHFT).  Led by the NTHFT Head of Community Services (who had worked within reablement provision for many years) and supported by the NTHFT Care Group Director – Healthy Lives, a presentation was given which covered the following:

·       NTHFT current role working alongside Stockton Reablement Service: With a focus on ‘Home First’ principles, the Trust’s priority was to get patients home from hospital as soon as it was clinically safe to do so.  Avoiding hospital admittance in the first place was also central to its thinking.

To facilitate this approach, NTHFT was a key partner within local integrated services, working alongside Stockton-on-Tees Borough Council (SBC) to provide an Integrated Single Point of Access (ISPA).  There was also a well-established Integrated Discharge Team (contributing to the Trust having one of the top performing Emergency Departments in England – a reflection of the strength of pathways in place to get people home), as well as a Community Integrated Assessment Team (CIAT) which worked in collaboration with the Reablement Service (30 clients on average per month, involving 80 contacts).

A change in delivery of the local Reablement Service from autumn 2024 had seen SBC bring the offer in-house.  From a NTHFT perspective, recent operational challenges had led to patients staying in hospital longer, though the Trust had worked with SBC for additional support to get individuals home for Christmas.

·       Case study – Support in the Community: A case study resulting in a referral to the Reablement Service was included as an example of the rising demand for this type of care.  Increasing frailty and complexity of cases across the general population was leading to greater challenges in providing support for those needing these services.  This example also involved a referral to the Virtual Frailty Ward (also known as the ‘hospital at home’ service) for further clinical assessments, treatment and observation.

·       Emerging system frailty model: Whilst there was estimated to be around 140,000 people aged over 65 within the Tees Valley footprint (15,500 of which had moderate or severe frailty and 5,500 of whom were residing in care homes), these numbers were expected to increase by over 20% in the next 10 years.  In order to meet this rising demand, NTHFT was developing a system frailty model which involved interventions ranging from emergency care within the hospital environment to self-care (including carer support).  Its aim was to help reduce hospital admissions and Accident and Emergency (A&E) attendance for those over 65 years-old, as well as reduce care home admissions.  The final model still needed to be approved by the Trust’s governance structure.

·       NHSE Frailty Strategy: The wider NHS England Frailty Strategy included a pathway to receiving reablement in the community.  This may or may not follow a period of care within a hospital setting, and the delivery of the strategy would require the support of a range  ...  view the full minutes text for item ASCH/52/24

Consideration was given to the latest Regional Health Scrutiny Update report which summarised the work of regional health scrutiny committees and highlighted some recent health-related developments impacting on the Tees Valley and / or wider North East and North Cumbria footprint.  Attention was drawn to the following:

·       Tees Valley Joint Health Scrutiny Committee: As part of the previously agreed rotational arrangements, Hartlepool Borough Council was hosting the Committee in 2024-2025.  The last meeting was held on 7 November 2024 where items included a North East and North Cumbria Integrated Care Board (NENC ICB) winter plan update, a briefing on opioid prescribing and dependency across the Tees Valley, the Tees Suicide Prevention Strategic Plan, and a Tees, Esk and Wear Valleys NHS Foundation Trust (TEWV) presentation on health inequalities.

The next meeting was scheduled for 9 January 2025 – anticipated items included a further TEWV update on Tees Respite Care, a Clinical Services Strategy Update (‘Group’ model), and a Palliative and End-of-Life Care Strategy presentation (the latter topic being something which the SBC Adult Social Care and Health Select Committee Chair (both current and previous) had sought clarity on for some time during informal engagement with NENC ICB officers).

·       Sustainability and Transformation Plan (STP) / Integrated Care System (ICS) Joint Health Scrutiny Committee: No further developments regarding this Joint Committee since the previous update in October 2024.  In related matters, regional developments highlighted included the ongoing promotion of the NHS ‘Be wise, immunise’ campaign to vaccinate high-risk people against COVID-19 and flu, the NENC ICB ‘Here to Help this winter’ webpage providing information on choosing the right NHS service for an individuals’ needs, new Government money to help people back into work by offering extra support in health services such as GP practices and hospitals, and calls to improve support for women through the menopause.  The link to the latest NENC ICB annual report and accounts (1 April 2023 – 31 March 2024) was again included for information.

AGREED that the Regional Health Scrutiny Update report be noted.

CHAIR’S UPDATE

The Committee Vice-Chair (acting as Chair for this meeting) relayed the Chair’s thanks to Stockton-on-Tees Borough Council (SBC) staff for their contribution to the recent Care Quality Commission (CQC) inspection of the Council’s adult social care services.

Attention was drawn to a recent SBC Member Briefing Session outlining planned Stockton and Darlington Railway bicentenary celebrations during 2025 – this included engagement with the elderly population around their own experiences of using the railway.  Members queried whether contact would be made with local care homes, with the SBC Assistant Director – Adult Social Care / PSW agreeing to seek further clarity around what was intended.

WORK PROGRAMME 2024-2025

Consideration was given to the Committee’s current work programme.  The next meeting was due to take place on 21 January 2025 where the latest Teeswide Safeguarding Adults Board (TSAB) Annual Report (2023-2024) would be presented.  Further evidence-gathering for the ongoing Reablement Service review was intended (featuring feedback on the work of SBCs delivery partner, Peopletoo), as was consideration of the CQC State of Care Annual Report 2023-2024 (alongside a reflection on the state of local provision).

AGREED that the Chair’s Update and Adult Social Care and Health Select Committee Work Programme 2024-2025 be noted.